NESCA is currently accepting therapy and executive function coaching clients from middle school-age through adulthood with Therapist, Executive Function Coach, and Parent Coach Carly Loureiro, MSW, LICSW. Carly specializes in therapy for individuals with Autism Spectrum Disorders and individuals who are highly anxious, depressed, suffer with low self-esteem, etc. She also offers parent coaching and family sessions when needed. For more information or to schedule appointments, please complete our Intake Form.

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attention

11
school student frustrated over the work

Navigating the Post-Honeymoon Phase: Signs Your Child May Need Support This School Year

By | NESCA Notes 2024

school student frustrated over the workBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

With the start of the school year well underway, we are beginning to see students and teachers settling into their classroom routines. Along with this increase in familiarity and comfortability, parents often start to see bits and pieces of challenges arise around this time of year that may have gone unnoticed during the initial “honeymoon period.” You may be wondering what challenges you should be looking out for and when those challenges warrant an evaluation to determine further supports and services. Let’s take some time to explore what to keep an eye on, and when it might be time to reach out to schedule an evaluation to dive a bit deeper into what is going on. 

Academics

No matter their age, if you ever feel your child is inundated and overwhelmed with schoolwork, it is a great idea to reach out to their teachers; ask how long homework should be taking and whether it should feel like review vs. new material. If homework starts to consistently become a battle, it might be worth taking a closer look into why. It could be because it’s a new and appropriately challenging course. It could also be because there are underlying language-based learning disabilities, a nonverbal learning disability, executive function challenges, or increasing symptoms of anxiety or depression. Some specific things to watch for:

  • Frequent tears during homework that appear to get worse instead of better
  • Not appearing to “get it” even after review and repetition
  • Difficulty studying/holding information in memory
  • Dysfluent reading or not understand what they’ve read
  • Challenges understanding math concepts or memorizing math facts
  • Difficulty applying and generalizing concepts
  • Opposition to handwriting tasks or when asked to compose a writing assignment
  • Poor penmanship that is illegible and/or immature for age
  • Not meeting benchmarks on assessments

Social Skills

At this point in the school year, children are typically starting to be interested in other peers within their classrooms. For younger kids, they are likely to feel more comfortable interacting with other children in their play. Common social concerns can include:

  • Not remembering any names or faces of kids in their class
  • Preferring to play alone, hesitant to join in with a group
  • Appearing unaware of social cues or how to initiate conversation with others
  • Rigidity in play—always wanting to play their own game by their own specific rules
  • Frequent peer conflicts and feeling rejected or left out

Emotional Functioning

A new school year often elicits feelings of anxiety in kids no matter how outgoing and social they may be! When might it be a sign that there is something more?

  • Continued and persistent resistance to going to school
  • Frequent somatic complaints with no apparent cause (e.g., headaches, stomachaches)
  • Change in sleeping patterns – not being able to fall asleep at night or waking up frequently
  • Difficulty with regulating their emotions/frequent tantrums
  • Changes in appetite
  • Negative statements about themselves
  • Increase in irritability
  • Withdrawal from others or previously preferred activities
  • Always wanting to know what is happening next and struggling with changes in routine (i.e., Does a substitute teacher derail their whole day? If a friend is out sick, is there a perseveration on where they are? Do you wait to tell them about changes in plans so they don’t worry in advance?)

Attention/Focus

Have you ever found yourself feeling restless and distracted when sitting through a work meeting? Kids are no different! Sitting still and paying attention for extended periods of time can be really tough – especially after being on summer break! Here are a few things to keep an eye on:

  • Frequently fidgeting in their seat or needing a fidget item to increase concentration
  • Difficulty with multi-step directions
  • Not remembering information presented during lectures
  • Acting impulsively
  • Easily distracted/daydreaming
  • Acting as if run by a motor
  • Blurting out thoughts, interrupting conversations
  • Teacher feedback that they are interrupting other students or not able to sit quietly and attend to class discussions

As always, you know your child best! If you feel like this year is off to a rocky start, or you’re starting to have questions regarding their functioning, do not hesitate to reach out and schedule an evaluation. A comprehensive neuropsychological evaluation is designed to look at ALL aspects of a child to determine what is getting in their way of reaching their potential. We are always here to help!

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, includingMiranda Milana Headshot attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

10

How Can a Neuropsychological Evaluation Help?

By | Nesca Notes 2023

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Recently I met with a family seeking a neuropsychological evaluation for their daughter. After talking about their reasons for pursuing testing, the parents asked me, “So…do you think this will help? Is this type of testing what our child needs?” It’s an important question and one I’m sure many families wonder about but don’t always ask. A comprehensive neuropsychological evaluation can be of tremendous value, but the process requires time and energy as well as a financial investment, so it makes sense to consider this question carefully.

Though it may be surprising to hear this coming from a neuropsychologist, the answer to the question of whether to have a child evaluated is not always clear-cut. For instance, parents sometimes wonder if there is practical benefit to seeking testing when a child or adolescent already has a diagnosis but there are questions about its accuracy. Consider the following scenario as an example. A child with issues regulating attention and with weaknesses in social skills has a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). Her therapist has raised the question of whether a diagnosis of Autism Spectrum Disorder (ASD) might better explain the issues the child is facing. Inattention can be present in both ADHD and ASD, and both conditions can result in social difficulties. Especially if a child is already receiving appropriate services, does the diagnostic label matter, and is it worth pursuing formal assessment?

There are valid arguments to be made in favor of seeking an evaluation in this type of situation and valid arguments to support choosing not to invest in an assessment.  In such a scenario, I would encourage a family to consider the following questions:

  • Will diagnostic clarification address unanswered questions that previous diagnoses have not fully addressed?

Sometimes an established diagnosis partially explains a child’s issues but there are lingering questions about other aspects of a child’s presentation. If a different or additional diagnosis could fill in the gaps, it may be worth assessing.

  • Could testing help identify your child’s unique pattern of strengths and weaknesses?

Especially when an existing diagnosis has been made without testing (for instance by a therapist or physician), there may be important aspects of a child’s neuropsychological profile that have not yet been identified. For instance, individuals with Autism Spectrum Disorder share certain key features, but they also differ in significant ways. A diagnosis alone cannot capture the nuances of an individual child’s strengths and weaknesses, while a full neuropsychological evaluation can more fully describe a child on an individual level.

  • Will understanding the root of the problem help guide recommendations?

NESCA’s clinic director compares a child’s observable difficulties to the “tip of an iceberg.” There are inevitably hidden underlying factors, and discerning these can be important in determining how to address the issues that are visible on the surface. For example, problems with social interactions can arise from deficits in social communication (e.g., difficulty interpreting facial expressions), as seen in Autism. Alternatively, a child with ADHD may encounter social challenges because they have trouble paying attention to relevant social cues or because impulsivity leads them to behave inappropriately. Someone with social phobia may have few relationships because their anxiety drives them to avoid social interactions. Effective intervention in each of these cases requires a nuanced approach that targets not just the surface issue but the factors underlying it.

  • Will establishing a particular diagnosis open up opportunities for additional support and resources that may be important?

In some cases, there are specific resources that are available to individuals with particular diagnoses. For instance, in Massachusetts, individuals with a diagnosis of Autism Spectrum Disorder or Intellectual Disability may be eligible to receive services through the Department of Developmental Services. If qualifying for such services could be beneficial, diagnostic clarification may be important.

More broadly, the internet and social media have allowed people with shared diagnoses to connect in new ways. The opportunity to connect with others experiencing similar difficulties can be invaluable, and online communities can provide a sense of support, educational information, and practical resources for children and parents alike.

The answers to these questions and to the bigger question of whether to seek neuropsychological evaluation will be different for different families. There are many factors to weigh in making the decision to seek testing. If you are considering an assessment for your child and need additional information to make an informed decision, answers to frequently asked questions about neuropsychological evaluation can be found on NESCA’s website.

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

 

To book a consultation with Dr. Rodriguez or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, Londonderry, New Hampshire, and staff in greater Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

10

Paying Proper Attention to Inattention

By | NESCA Notes 2022

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

One of the most common referral questions I see in my work as a neuropsychologist is, “Does my child have ADHD?” When a child has trouble focusing, Attention-Deficit/Hyperactivity Disorder, or ADHD, is one of the first things that comes to mind, and for good reason. However, ADHD is only one potential underlying cause of inattention. In fact, there are many cases in which attentional difficulties are present as part of another underlying issue. Some of these include:

  1. Anxiety—On a physiological level, anxiety involves activation of the “fight or flight” response. This adaptive process is designed to alter attention in order to prioritize survival. When the brain senses a threat, it tunes out everything else so it can focus on dealing with the danger at hand. This is extremely useful when the threat is something like a wild animal chasing you. In that case, you need to momentarily shift all of your attention to survival. It’s the worst possible time to be distracted by anything that could divert your attention from escaping a dangerous situation. But when students are anxious, especially for extended periods of time, the same process can make it difficult to focus on day-to-day tasks, including learning.
  2. Learning Disorder—Students who lack the academic skills to engage with the curriculum can appear to be simply not paying attention. If a student’s reading skills, for instance, are several grade levels below expectations, they won’t be able to actively engage with written assignments or materials in class.
  3. Communication Disorder—Deficits in receptive and/or expressive language often manifest in ways that mimic inattention. If a child cannot grasp what is being communicated, they will have significant difficulty following verbal instructions, answering questions, and retaining important information. This can easily be misinterpreted as a sign of an attentional issue when, in reality, the underlying problem has to do with communication.
  4. Autism Spectrum Disorders (ASD)—Many individuals on the Autism spectrum tend to be more attuned and focused on internal experiences (e.g., their own thoughts and specific interests) than to the external environment. As a result, they can miss important information, ranging from social cues to expectations communicated at home or within the classroom.
  5. Other neurocognitive disorders—Weaknesses in other cognitive functions, particularly those we refer to as “cognitive proficiency” skills (e.g., processing speed) and executive functions (e.g., working memory, organization) can also result in apparent inattention. Students who cannot process information quickly are sometimes unable to keep up with the pace of instruction, which causes a diminished ability to comprehend and retain information. Similarly, students who cannot hold information in working memory or organize ideas and concepts can demonstrate reduced comprehension.

There is a range of other issues that can contribute to children or adolescents appearing inattentive. Some of these include trauma, absence seizures, hearing impairments, thought disorders and/or hallucinations, and Tourette’s Syndrome. It is important to thoroughly evaluate the potential causes of inattention and to consider an individual’s full history and presentation.  Because different underlying issues will necessitate different treatment approaches, getting to the root of the issue can be tremendously important.

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

 

To book a consultation with Dr. Rodriguez or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

1

Why Delay a Diagnosis?

By | NESCA Notes 2022

By Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

As part of NESCA’s ongoing blog series addressing some of the most frequently asked questions about neuropsychological testing, today we are addressing why neuropsychologists may choose to delay a diagnosis.

At NESCA, I often supervise neuropsychology trainees, and one of the first questions I asked them is: “What is the goal of a neuropsychological evaluation?” I often hear answers, such as “to identify strengths and weaknesses” or “to determine appropriate diagnosis.” These answers are not wrong, per se – they are what we are taught in graduate school. However, I often explain that while these may be part of our goal, the primary goal is to tell a client’s story and help them understand a path for moving forward. While this may sound a bit aspirational, it is the approach that best appreciates developmental, systemic, and individual factors that may come into play. As addressed by Dr. Moira Creedon in the first blog within this series, this is also one of the reasons why neuropsychologists want to review all prior evaluations and documentation, as this helps to elucidate the developmental timeline.

When a neuropsychologist is approaching an evaluation through the above developmental lens, it is not always possible to land on a specific diagnosis. This may sometimes be referenced as a “deferred diagnosis” or “differential diagnosis,” meaning there is evidence to possibly support the diagnosis, but not enough evidence at this time to decide for certain. Another term that may be used is “provisional diagnosis.” This indicates that there is enough evidence to support the diagnosis at this time, and there is clinical utility to diagnosing (e.g., informs intervention, qualifies for services, etc.); however, more information or monitoring may be needed to be completely confident, so future reassessment is warranted.

There are several reasons why a diagnosis may be deferred or deemed provisional. First, children are constantly developing, and sometimes the challenges they are demonstrating may be developmental in nature. This may be particularly so when evaluating young children. For example, if a young child has significant language delays, it may be difficult to assess whether they are also on the autism spectrum or have early signs of a learning disability, as their observed weaknesses in these areas may be accounted for by their language. Often times these are children who may “catch up” in skills once provided intervention, meaning their difficulties were related to delayed acquisition, rather than an being an issue of innate impairment.

Similarly, another reason diagnosis may be deferred is if a child’s self-regulation challenges interfere with their ability to engage in typical daily demands. For example, for a child who has significant anxiety or behavioral dysregulation that interferes with their ability to engage in school, it may be difficult to determine if academic delays are related to a learning disability or are a secondary consequence to their dysregulation. While provision of targeted instruction may still be necessary in order to help the child regulate and close gaps in skills, a full understanding of their innate learning profile may not be possible until such supports are in place.

Deferred diagnosis is quite common when more significant psychiatric diagnoses are in question, such as whether a child or adolescent is presenting with a mood or thought disorder, such as bipolar or emerging psychosis. There are many other conditions that may “look like” these disorders, including trauma or co-occurring anxiety and ADHD. When diagnosing more significant, often life-course disorders, it is important to ensure that all other potential explanations are identified and addressed. This is important for informing the appropriate treatments while also allowing the evaluator to outline some of the “red flags” that should be monitored by the client, their parents, and their care team over time.

Another reason why a diagnosis may be deferred is that there may be systemic factors at play. In other words, there may be things going on within the child’s home, peer setting, school, or other surroundings that interfere with the evaluator’s ability to understand the child in isolation. This is a particular issue when evaluating a client with a trauma history. Developmental trauma can often “mimic” other symptom profiles, and so it may be important to first address issues within the system before providing a diagnosis for the individual.

There are other less common situations in which diagnosis may be deferred, but they warrant mention. One is when the neuropsychologist is concerned about possible malingering, which is when certain symptoms are being falsified or exaggerated for personal gain (e.g., a child with learning disability exaggerating mood symptoms to avoid school). Another less common situation is when prescribed medication or recreational drugs may be inadvertently causing the symptoms of concern (e.g., depression occurring as a side effect).

A final reason why a diagnosis may be deferred is simply that things can sometimes be messy. We often evaluate children and teens who have several presenting concerns, and sometimes it takes time to peel away the layers of the onion. In any of the above scenarios, we start with “what we know” and then describe “what is possible.” Regardless of whether or not a diagnosis is certain, as neuropsychologists, we are still able to tell the client’s story, describing how they “got here” and how to move forward. This developmentally-sensitive approach allows us to make recommendations based on their need, not just their diagnostic label. We are then able to assess how their profile and symptoms change as they access intervention. It is for this reason that we enjoy the opportunity to develop long-term relationships with our clients, helping to monitor growth over time. Children do not develop in one finite time point, and the neuropsychological evaluation process sometimes has to be patient and continue to develop alongside them.

 

About the Author

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

9

ADHD & Social Skills

By | NESCA Notes 2022

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

When most of us hear the term “ADHD (attention deficit hyperactivity disorder),” we think of the little boy who can’t sit still at his desk or the girl gazing out the window lost in her own thoughts during class. While difficulties with hyperactivity and/or attention are core features of ADHD–embedded directly in the diagnostic label–there are often co-occurring features that are less obvious. Moreover, even the central aspects of ADHD can have far-reaching impacts beyond the classroom. One of the most frequently misunderstood and overlooked facets of ADHD is its potential impact on social functioning.

In clinical practice, parents of children with ADHD are often confused by the unexpected and indirect ways that attentional and executive functioning deficits can affect social functioning. They sometimes wonder if their children have an additional challenge, such as autism spectrum disorder. Most often, that’s not the case. Rather, it’s more likely that one or more of the following is at play:

  • Kids with ADHD can have difficulty selectively attending to relevant social cues
    • Imagine looking through a camera with a broken zoom lens. At first everything is in frame at once; it’s too much information. Then you try to zoom in, but when you do, sometimes the lens focuses on unimportant things (like the random details in the background), leaving out what’s most relevant (like the person you’re trying to capture in your photo). Children with ADHD have difficulty figuring out what details to focus on and struggle to effectively “zoom in” on those elements. In social settings, which are often unstructured, kids with ADHD are even more prone to “zoom in” on unimportant things and miss the more salient information. They can also become easily distracted and fail to register important information in the moment. To others, this can come across as lack of interest (for instance, the child who seems not to be listening or is distracted by sounds, sights, or other sensory information in the moment). It can also lead children with ADHD to overlook contextual cues about what’s expected in a given social setting, which can lead to inappropriate behavior.
  • Children with ADHD often struggle with nuance, making inferences, and reading between the lines
    • Social situations are much more complex than we often realize. Successfully navigating social interactions requires paying attention, not just to surface level information but to the often subtle, implied meaning embedded in things like figures of speech, tone of voice, and body language. For many with ADHD, it’s already a challenge to maintain focus at the surface level; the task of trying to simultaneously attend to and interpret subtext is too much. Individuals with ADHD may focus on what another person says (the content of their speech) but fail to notice the eye roll or sarcastic tone of voice that goes along with it.
  • Impulsivity can lead to social faux pas
    • Impulsivity is a central feature of ADHD in many cases. In social settings, difficulty inhibiting impulses can take many forms. For some, it may simply present as rapid-fire speech, leaving little room for others to respond in conversation. It can also look like interrupting, cutting others in line, or expressing ideas and opinions in a way that can be hurtful or seem rude. Especially in younger children, impulsive behavior can lead to difficulty sharing, physical aggression towards others, and trouble with turn taking. Children who have more difficulty slowing down and inhibiting impulses are more likely to inadvertently offend others or to engage in behavior that their peers may view as odd or inappropriate; in turn, this can lead to trouble developing and sustaining friendships and other positive relationships.
  • Hyperactivity makes participating appropriately in some social settings difficult
    • There are some social contexts in which an abundance of energy is a very good thing. For this reason, many ADHD kids can excel in activities like sports, into which they can channel their high energy. But other social situations demand a different set of skills. For kids with hyperactivity as part of their ADHD, sitting still and maintaining quiet can be a challenge. They may struggle with activities like going to the library, watching a movie in a theater, attending church or religious ceremonies, or sitting at the table in order to have family dinner.

The good news is that there are ways to manage these social challenges. If your child with ADHD has difficulty with any aspects of social functioning, it may help to seek out social skills training with a therapist or through a structured social skills training program. Interventions often include a combination of explicit instruction, modeling, role playing, and feedback. Parents can also help by implementing simple, consistent ground rules for behavior and providing gentle but clear reminders as needed. Additionally, parents can facilitate play dates with peers, during which the parents take an active role in helping children utilize social skills and engage with each other appropriately.

Finally, though ADHD can present challenges in the social domain, kids with ADHD often possess many strengths that can help actually them succeed socially. Children with ADHD can be highly engaging, curious, energetic, creative, and open-minded. When these strengths are reinforced, kids with ADHD can often utilize them to create fun, rewarding social interactions and to develop rich, dynamic relationships.

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

To book a consultation with Dr. Rodriguez or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

157

Therapeutic Toy Guide to Promote Skill-building

By | NESCA Notes 2021

By: Jessica Hanna MS, OTR/L
Occupational Therapist, NESCA

It’s that time of year when parents and loved ones are looking for the perfect gift. As pediatric occupational therapists, we are often asked about our recommendations for the best toys and activities that encourage learning and the development of specific skills. During an occupational therapy session, toys and games are used with people across the life span for many reasons. The biggest reason is to bring joy and develop confidence while simultaneously working on skill-building in areas that require getting and maintaining attention in an effort to improve and develop independence in functional tasks.

Play and exploration of games and toys are for those of all ages. The right toy and game can be used to develop new skills and strengthen and refine learned skills.

Skills addressed through play and active exploration:

  • Attention and concentration
  • Balance
  • Coordination skills
  • Core strength
  • Executive functioning
  • Emotional regulation
  • Fine motor skills
  • Gross motor skills
  • Handwriting
  • Imaginative play
  • Motor planning
  • Sensory motor needs
  • Visual perceptual skills

How many times have you endlessly scrolled online looking for the best-fit gift, wondering if it will be one more item that ends up collecting dust on a shelf? How often do you wish a toy store existed like when we were kids, instead of walking down the same small toy aisle at the local department store and leaving with nothing? Or having to weed through page after page of online stores and catalogs?

Below is a helpful guide to therapeutic games and toys that focus on a couple of specific skill areas. Most of the games included can fall into more than one skill area, depending on how it’s used.

Coordination Skills – Skills that help develop body control and awareness. Bilateral coordination is the ability to use both sides of your body together in a coordinated way, and hand-eye coordination is when the eyes guide the hands in movement.

3 + years

  • EleFun (Hasbro)
  • Feed the Woozle
  • Kids Magnetic Fishing Games (iPlay, iLearn)
  • Instrument toys
  • Marble Run
  • Target activities
  • The Yoga Garden Game
  • Wooden Balance Board
  • Zoom Ball

6 + years

  • Bob it
  • BucketBall
  • Kan Jam
  • Klask
  • Rev balance board
  • Ring Toss
  • Simon
  • Spike Ball
  • Throw the Burrito
  • Twister

Executive Functioning Skills – The ability to sustain attention, organize and plan, initiate and complete, problem solve and regulate emotions.

3 + years

  • Bee Genius (MUKIKIM)
  • Bunny Hop (Educational Insights)
  • Cootie
  • Create-A-Burger (Lakeshore)
  • Dino Escape
  • Don’t Break the Ice
  • Frankie’s Food Truck Fiasco Game
  • iPlay, iLearn Kids Magnetic Fishing Games
  • Hoot Owl Hoot
  • Movement Memory

 6+ years

  • Battleship
  • Checkers
  • Chess
  • DogPile
  • Distraction
  • Gravity Maze
  • Life Junior
  • Monopoly
  • Outfoxed
  • Rush Hour (Think Fun)

Fine Motor Skills – The ability to control the small muscles of the hands and fingers. Fine motor development contains many components. Some of those areas include pincer and pre-writing grasp development, hand strength, wrist stability, motor control, and separation of the sides of the hand.

3 + years

  • Alphabet Learning Locks
  • Bee Genius
  • Duplo Sets
  • Forest Friends Playset (Lakeshore)
  • Light table pegs and pegboard (Lakeshore)
  • Magnet Alphabet Maze
  • Noodle Knockout!
  • Pegcasso Build and Drill
  • Poke-a-Dot: Old MacDonald’s Farm
  • Pop the Pig
  • Woodpecker feeding game (iPlay, iLearn)
  • Snap Dinos (Lakeshore)

6+ years

  • Frankie’s Food Truck Fiasco Game
  • LEGOs
  • Light Brite
  • LiquiPen (Yoya Toys)
  • Mancala
  • Kanoodle
  • Operation
  • Perfection
  • Pictionary
  • Scratch Art
  • Shelby’s Snack Shack Game
  • Trouble

Sensory Play – The opportunity to receive sensory input through play. It can foster listening skills and body awareness, encourage tactile exploration and risk-taking, and promote a calming and alert state of being.

3+ years

  • Bean bags
  • Kinetic Sand
  • Monkey Noodle
  • What’s in Ned’s Head?
  • Playdoh
  • Pop Fidgets
  • Squishmellos
  • Scooter boards
  • Sit and Spin
  • Trampoline

6 + years

  • Aromatherapy
  • Bubble tubes
  • Color mix sensory tubes
  • Doorway Sensory Swing Kit (DreamGym Store)
  • Thinking Putty (scented/glow in the dark)
  • Tent
  • Tunnel
  • Water Beads
  • Weighted blanket
  • LiquiPen (Yoya Toys)

Visual Perception Skills – The ability to make sense of what is being seen. Skills are used to copy information from a board, manipulate items, identify, read, recall info, visually locate things, and write.

3 + years

  • Alphabet Bingo
  • CandyLand
  • Chutes and Ladders
  • Fox in the Box
  • Honeybee Tree
  • Magnatiles
  • Spot-it
  • Pete the Cat- I Love My Buttons Game
  • Puzzles
  • Zingo (Think Fun)

6+ years

  • Connect Four
  • DogPile
  • Guess Who
  • Jenga
  • Kanoodle
  • Klask
  • Let’s Go Code
  • Mancala
  • Perfection
  • Pixy Cubes

This list is just the tip of the iceberg of the many toys and games you will come across. Many toys and games can be therapeutically and easily graded to any individual, no matter the age. The trick is to find the just-right challenge to work on the skill area desired through fun and motivating means. We recommend reaching out to your occupational therapist if you require assistance with either new or older games and toys and how to create the just-right challenge for your child.

 

About the Author

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

3

Good Night, Sleep Tight: What if I Can’t Sleep Right?

By | NESCA Notes 2020

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

The American Psychological Association recently issued a press release about the impact of the COVID-19 pandemic on our dreaming. Not surprisingly, the information in four published articles indicates that people are having more anxious dreams now. This seems obvious given the emotional toll and high levels of stress as everyone juggles work, virtual school, health and safety, and family needs in a pandemic. We have an overflowing plate of stress on our hands with distant notions of when this stress will end. While these articles describe the anxious dreaming and sleep of adults, it’s not a stretch to consider that children and teens may have disrupted sleep right now. Their plates are overflowing, too, as they manage virtual and hybrid learning, confusing social demands, less movement and exercise than usual, and less contact with both adults and kids.

We cannot underestimate the importance of sleep to our system. Sleep is when our body restores itself, builds important immune functions and consolidates memories and learning. When children do not get enough sleep, we can see a whole host of problems, including issues with attention, concentration, learning, irritability, poor emotion regulation and risky behaviors in addition to the physical health outcomes.

What do we do to help our kids and teens get more and better sleep? It’s time to get sleep hygiene back on track. It’s possible to do even if the pandemic has caused the norm to drastically shift. Here are some tips for promoting sleep for children and teens:

Establish a consistent schedule. I cannot emphasize this one enough. Establish consistent times for settling down for bed and waking up that are the same every day of the week. Try to stick to this schedule whether your child is having an in-person learning day or remote, whether it is a weekend or weekday. This can be tricky with teenagers who tend to sleep in on weekend days. Try to stick within an hour, if possible, to get your body on a more consistent schedule. Avoid naps during the day if you can, even if there has been a rough night of sleep (or limit naps to less than 30 minutes). Daytime napping can interrupt night sleep patterns.

Develop a routine to settle for bed. Children and teens need to settle down for bed gradually. We can’t go from wide awake to peaceful slumber in a few moments. Limit screen time 30 minutes before bed as the light that is given off by televisions, phones or other devices confuses our systems and causes delays in releasing melatonin (the magic sleep hormone). Choose the same relaxing activity each night. Children and teens can read (or listen to a story read aloud by a parent), listen to an audiobook, color in special coloring book, listen to music or a podcast, or take a warm bath or shower. Include your child or teen in conversations about what relaxing activity to try before bed. Keep the same activity for several weeks before trying other ones. The brain does not want variety when you are trying to settle for bed, or it can become more alert in the face of a novel activity. The routine promotes relaxation.

Schedule talk time. Children and teens tend to think about their day as they are laying down. This can lead to “just one more thing” that kids have to tell us or one more question. They can also anticipate what is happening next, which can lead to an increase in anxiety. Schedule a “talk time” with your child or teen to discuss the day and think ahead to tomorrow. Do this at least 30 minutes before bedtime (ideally closer to dinnertime) to avoid a lengthy conversation that can activate anxiety. Use this time to validate feelings and model problem-solving about any issues coming up.

Provide comfort after dreams. We can expect that everyone may wake up at some point after an anxiety dream. If we can predict it, it can make it feel less overwhelming. Teach children and teens what to do when they wake up feeling anxious, including seeking the support of their parent for the very upsetting ones. Offer comfort and a tuck back into bed. Encourage your child to talk about how to resolve the frightening dream in a way that is silly, funny or triumphant to shift the focus away from what felt upsetting. Have a scary dream about a monster? Imagine him having to perform a ballet while balancing hot sauce on his head. Have an anxiety dream about a teacher yelling at you for forgetting your homework? Imagine turning it in and your teacher leading the rest of class in a celebratory song. You can also encourage children or teens to think of their favorite movie or book, and ask them to close their eyes and replay the movie or book to refocus the mind.

Practice breathing. To soothe our overactive anxiety systems, practice taking deep breaths. Imagine your breath filling up the back of your lungs and visualize the air going through your body. Practice circle breathing where air comes in one nostril and out the other (of course it comes in and goes out both!).  With younger kids, a little modeling helps. You can also encourage kids and teens to tense different parts of their body, hold for a count of 10, and then release to feel more relaxed.

Reach out for help. If your child or teen has persistent trouble with sleep, contact your pediatrician. It may be time for a more thorough evaluation to rule out sleep disorders, medical causes or behavioral patterns that signal a bigger sleep problem.

 

For more information, please check out these resources:

American Psychological Association (APA) press release related to dreaming:  https://www.apa.org/news/press/releases/2020/09/upsetting-dreams-covid-19

Fantastic APA resource on sleep: https://www.apa.org/monitor/2020/07/ce-corner-sleep

What To Do When You Dread Your Bed: A Kid’s Guide to Overcoming Problems with Sleep (2008) by Dawn Huebner, Ph.D.

 

About the Author: 

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form. 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

150

OTs’ Remote Learning Equipment Tips!

By | NESCA Notes 2020

Co-authored by: Sophie Bellenis OTD, OTR/L and Jessica Hanna MSOT, OTR/L

With the momentous shift in education this year, many families are looking for support with the remote learning or hybrid learning process. Children are facing new barriers to education, such as inability to focus within the home setting, inappropriate work space and lack of independence with attention, initiation and motivation. Fortunately, many fabulous educators are stepping up to the plate, acknowledging these struggles and advocating on behalf of their students. Many families are working to help in their efforts by finding new products, tricks, tools or strategies to help promote learning and access to curriculums. Some of these products are gimmicky tools promising a “quick fix.” Some of these new tricks and tools may be beneficial, but today we are going to advocate for getting back to the basics and truly analyzing how best to use, set up and care for the foundational tools that children currently employ for learning. If using these tips feels difficult or is not helping your child to achieve the level of focus and commitment to learning that they need, we recommend reaching out to your school-based occupational therapist or getting an occupational therapy evaluation.

Things to Consider:

Laptops/Tablets

  • Basic Functionality – Your child is never too young to be part of the process. Teaching your child basic functionalities of their computer and tablet, as well as specific platform features is hugely important. Your child may find a visual checklist helpful to recall what basic features do, where to find them and when it is ok to use them.
  • Keep Screens Clean – As expected, kids often touch everything and anything, including computer and tablet screens. Make sure to check and wipe down screens to limit glare and distortion caused by sticky little fingers. Encourage your child to respect and handle their device with care.
  • Screen Height – According to the American Optometric Association, most people find looking at screens more comfortable when their gaze is pointed slightly down. Ideally, try to set up a computer screen with the center of the screen about 15-20 degrees below eye level (AOA, n.d.). This may be especially tricky with little learners, who tend to crane their necks up to look at a monitor or laptop screen, or students who tend to set their laptop way down on their lap.
  • Screen Distance – To decrease eye strain, try to position a screen about 20-28 inches away from the eyes (AOA, n.d.). Recent evidence shows that there is a significant increase in visual symptoms, such red eyes, blurriness and visual fatigue in individuals who look at screens from a distance of 10 inches or less (Chiemeke, Akhahowa, & Ajayi, 2007). While it is easy to set a computer a certain distance away, make sure that children are not holding an iPad or phone right up to their face during the school day.
  • Simplify Access to School Webpages and Links – Make sure that when your child opens up the computer, they can quickly and easily access all of their school websites and links for Zoom, Google Classroom, etc. One easy way to do this is by creating shortcuts on the desktop or having a visual guide printed next to them for exactly how to access their work.
  • Limit Access to Distracting Apps or Webpages – Is there a way to disable your child’s access to games and apps during school hours? While our students are working hard to attend to remote learning, the pull of distracting digital fun may be too enticing to pass up. Consider looking into some of parental control options on your device.
  • Learn the Limitations of Chromebooks – Due to the digital demands of remote learning, many school districts and community organizations are providing Chromebooks for students to use at home. While this is excellent and allows students access to the curriculum, some of these devices have limitations, such as not allowing communication to certain website or software platforms. Consider reaching out to your district if you need your child’s device to allow communication with an outside therapist or service provider.
  • Back Up Your Personal Work – Many families are sharing one computer or device between multiple family members. It is important to make sure that any important documents, folders or programs are fully backed up before giving a computer to your student. Accidents happen, and children can quickly delete files without meaning to! Creating a separate user login for each family member allows different privileges for each user and helps keep work separate and organized.
  • Say No to Open Drinks! – Water bottles with a lid will help to prevent any hardware damage from spills.

 Extra Equipment

  • Invest in a Mouse – Using a touchpad often requires substantially more fine motor precision and finger isolation than using a mouse. Most devices can connect with a mouse either through a USB port or a Bluetooth connection.
  • Headphones – Different children may benefit from different types of headphones. Some of our learners need earbuds or overhead headphones during Zoom meetings to help them attend to the class going on virtually. Some of our students may prefer being in a quiet space and listening to their teacher and classmates out loud. Additionally, some students may benefit from wearing noise cancelling headphones during independent work to limit the distraction from noises in their environment.
  • External Camera – Using an external camera that is not embedded in a computer or laptop may be helpful for our students who need movement or want to look at a screen while a teacher or therapist observes their work. An external camera pointed down at a student’s hand during an activity can help a therapist to evaluate a child’s fine and gross motor movements, while the student still sees a friendly face up on the screen.
  • Chargers – Help your children remember to keep their devices fully charged and to transport their charger between school and home if necessary. Many students benefit from a visual checklist when packing their bag for the next day. Chargers are hugely important for students who need to access their curriculum and may be especially difficult for students learning in a hybrid model.

 

References

American Optometric Association. (n.d.). Computer vision syndrome. Retrieved from https://www.aoa.org/patients-and-public/ caring-for-your-vision/protecting-your-vision/ computer-vision-syndrome?sso=y

Chiemeke S.C., Akhahowa A.E., Ajayi O.B. (2007) Evaluation of vision-related problems amongst computer users: a case study of university of Benin, Nigeria. Proceedings of the World Congress on Engineering. London: International Association of Engineers.

 

About the Co-authors:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

150

The Ideal Remote Learning Workspace

By | NESCA Notes 2020

Co-authored by: Sophie Bellenis OTD, OTR/L and Jessica Hanna MSOT, OTR/L

Designated Space for Schoolwork – Make sure to set up a workspace with intention. While it may be easy to have children hop on the couch or sit at the kitchen table, having a space that is specifically used for academics will help them to compartmentalize and associate the space with focus and learning. There should be a concrete difference between a place to work and a place of rest. Ensure that this space is distraction-free and set away from the hustle and bustle of the home. Give your child some autonomy by allowing them to decorate their space and take ownership. A small desk, a card table in a quiet corner or a small bedside table set up in a private space are all options for workstations that children can make their own.

Remove Distractions – Take a moment to sit down at your child’s workstation and note any potential distractions. Some will jump right out, such as a TV or box of enticing toys within their line of sight, but some may be less obvious. Are they near a window facing a busy street or a dog park? Is there a substantial amount of visual clutter around their desk, such as busy posters or a family photo collage? Is their desk covered in mail, knickknacks, or arts and crafts supplies? If removing items is not an option, consider creating a physical barrier between your child and any environmental distractions by using a desktop study carrel/shield. Taking these distractions away will help a student to focus their energy on attending to school, as opposed to ignoring it and resisting distractions.

Organize Materials – Depending on your child’s age, they may need help organizing their workspace to be prepared for the day. For our young students, consider using toolboxes or tabletop organizers to hold their materials. A toolbox may have crayons, markers, scissors, pencils, erasers and glue sticks. If your child benefits from sensory supports, consider a toolbox with manipulatives, as appropriate per occupational therapy (OT) recommendations. Children are often very visual learners and may benefit from color-coded or designated folders for each subject or class they are taking. If a workspace is shared, keep your child’s personal materials all in one location, such as a personalized storage container that is easily portable, accessible and organized. Finally, remember to consider digital organization. Students are often told how to label and save documents by teachers at school. With the move to remote learning, children may need assistance organizing documents, folders and classwork on their computer so that they can easily find everything in the moment.

Adequate Lighting – Assess the lighting in your student’s workspace by checking to see whether there is any glare from the sun on the screen, whether they could benefit from a desk lamp to better illuminate their paper and determine whether there is a specific location with good natural light. If natural light is preferred, it’s best practice to position your electronic at a right angle to the light so the light is neither in front nor behind the screen. Avoid fluorescent light bulbs whenever possible. One more thing to consider is the fact since this past March, students and professionals alike have noticed an increase in headaches and visual fatigue due to spending substantial portions of the day in front of a screen. Technology is visually straining. Consider investing in a pair of blue light-reducing glasses, a newly popular solution to this problem that has shown promise for improving adolescent sleep, mood and activity levels (Algorta et al., 2018).

The Rule of 90 Degrees – When sitting at a table, children’s hips, knees and elbows should all be positioned at 90 degrees. Feet must be firmly planted on the floor. This helps to create a solid foundation. When children have a strong foundation and postural stability, they are set up to freely and accurately use their fine motor skills. Being grounded allows for easier writing, typing, cutting and manipulation of all the tools necessary for learning.

Appropriate Furniture – To meet the Rule of 90, it is important to consider the furniture that your student is using. Furniture needs to be the correct size or be modified to help children fit comfortably. If a desk/table is positioned too high, it will cause extra strain and fatigue. If your child’s feet do not reach the floor, consider using a step stool or fortified box for their feet. With regard to the chair itself, avoid options that spin and slide around as they are often distracting and make it difficult for children to pay attention.

 

 

 

References

Perez Algorta, G., Van Meter, A., Dubicka, B. et al. Blue blocking glasses worn at night in first year higher education students with sleep complaints: a feasibility study. Pilot Feasibility Stud 4, 166 (2018). https://doi.org/10.1186/s40814-018-0360-y

 

About the Co-authors:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

152

Sensory and Motor Strategies to Support Online Learning

By | NESCA Notes 2020

By: Julie Robinson, OT

Director of Clinical Services; Occupational Therapist, NESCA

For many families, this spring’s experience of remote learning and receiving integrated services was challenging, to say the least. As parents begin to think about their children returning to school this fall questions and concerns arise, not only about regression, but also how they will keep their children engaged in online learning.

For children with sensory processing difficulties and/or motor delays, there may be additional challenges in participating in Zoom classes and remote group learning. Some may have difficulty sustaining their attention, settling their body down to sit in front of a screen, managing the visual challenges of a screen, engaging socially or transitioning from a desired task to an academic one. Below are some suggested strategies, from an OT perspective, that may help your child participate in academics with less stress.

Regulation Strategies

The term “regulation” refers to someone’s ability to match their level of alertness (or arousal) to the environment and an activity. Throughout the day, our brain and our bodies are working to either increase or decrease our arousal levels for us to feel regulated and feel “just right” for the situation.

Sometimes children may have trouble with regulating themselves, causing them to experience dysregulation. Dysregulation can look very different depending on the child and can present as low levels of arousal or high level of arousal. This state may make it challenging for the child to be engaged and participate in certain activities, such as online learning. Sensory strategies are ways to help a child either increase arousal or lower arousal to match the needs of the task of online learning.

If a child is experiencing a low level of arousal, or their engine is running low, they should use a sensory strategy to help feel more alert. These include activities that have fast movement and increase heart rate. Taking movement breaks throughout the day is key! This could mean:

  • Jumping Jacks
  • Frog jumps or jumping on a trampoline
  • Playing at an outdoor playground
  • Creating an obstacle course
  • Doing something as simple as taking a walk around the house
  • Using a sit and spin or bouncing on a therapy ball
  • Hanging from a chin-up bar

If a child is experiencing a high level of arousal and their engine is running high, a sensory strategy to help them feel calm is beneficial. Calming strategies tend to be slower and more rhythmic. Ways to help slow down a child’s engine include:

  • “Heavy work,” such as wall push-ups, carrying books, laundry or groceries, wheelbarrow walk or crab walk can do the trick.
  • Yoga poses. Cosmic Kids Yoga on YouTube has some good videos with stories to encourage young children.
  • Creating a “sensory space” that is quiet and free from distractions. This could be a beanbag chair in the corner, a pop-up tent or a space behind a piece of furniture.
  • Using a weighted/heavy blanket or doing work on the ground with pillows underneath while spending time online may help your child to settle his or her body down. Explore the use of a therapy ball, T-stool, Move and Sit cushion or bike pedals that go under a chair to help kids who have difficulty sitting still.
  • Tactile play can be very calming for some children. Make a bucket of beans and hide small objects in it. Working with Playdough, shaving cream or water play can also help.
  • Encourage deep breathing to promote relaxation. Blow soap bubbles with a straw, pretend to blow out candles or blow a pinwheel.
  • An icy drink or popsicle can prove calming for many children. Or allow them to chew gum while learning to facilitate attention.

Strategies for Transition into Online Learning

As the new school year approaches, the change of routine into online learning may be a challenge for some kids. Here are some strategies to help your child adjust:

  • Create a clear schedule for your child that they can follow throughout the day (and make sure to schedule in plenty of breaks!). It may be helpful to use visuals or pictures, similar to a preschool schedule to help structure the time.
  • Make time for movement breaks around the house or outside. It may help to engage in a movement activity for 10-15 minutes before settling into an online class.
  • Use timers when needed (apps that have a visual timer, such as “Time Timer,” can be beneficial).
  • Create a designated space for the child to do their learning and make it their own.
  • Factor in a reward for good participation at the end of a virtual learning session, particularly for a child who seems resistant to remote learning.
  • Practice some brief online learning opportunities before school begins and slowly increase the time incrementally. Conduct Zoom calls with grandparents or other relatives where they read to the child to help maintain their attention. Search on YouTube together for some craft activities to follow along with. Khan Academy and Outschool have all kinds of online lessons for kids of all ages.

 Preventing Visual Fatigue in Online Learning

Along with the many challenges that come with online learning, the constant staring at electronics can cause strain or fatigue on the eyes. Eye strain can present as headaches, blurry vision, tired eyes and neck aches. In this world of virtual learning, it is more important than ever to help kids with strategies to prevent digital eye strain. Here are some strategies:

  • Turn down the screen brightness and turn up the contrast on screen settings.
  • Every 15-20 minutes, make sure to take a break from looking at the screen; set timers if needed. Sometimes placing your hands over your eyes and staring into them with open eyes can help. No matter what the day’s schedule is, always encourage a break from looking at the screen when needed.
  • Zoom in when text is too small.
  • Set limits for recreational use of electronics and avoid electronics before bed.
  • Sit in an ergonomically proper position when using the computer. This means keeping feet flat on the floor, lower back supported and shoulders related, and arms at a right angle.
  • Position the screen to avoid glare and use natural lighting as much as possible.
  • For a child who may have difficulty looking back and forth from a screen to paper, it may help to place the paper on a contrasting background of red or yellow.

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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